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SAN JOAQUIN <br /> r. —COUNTY— Environmental Health Department <br /> r l,FO. Greotnes5 grows her,. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: inspector: 5c,ViyyAS, CONSTRUCTION <br /> Facility Address: GOOD Aicoodr WoA <br /> Well Address: Total Depth: <br /> WP#_Obk5088 Well#: Drilling Rig Type: <br /> Soil Boring#: ( Ag Drilling Company: wo, MILUInjMin 2" Annular EHD Seal Verified: ElYes ❑No <br /> Driller Onsite: Screen Length From: To; <br /> Consultant: pj%4L (}ggp(�a{Q� Filter Pack From: To: <br /> Geologist: Nris Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑ Yes []No casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND c�talsTYaox <br /> Holding Temperature: CONi'LETION cotiPlETiON <br /> Method: Gmdrd Su1ac• —F— <br /> Screening Method: grrmd <br /> Verified Chain of Custody: ❑ Yes ❑No tt• <br /> SPOILS tt. <br /> n. <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: no ua <br /> Covered: El Yes ❑No wc+on = 8 <br /> gnvat Pack <br /> If yes, material: c <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: IIIJW7 CjeW`2/L+ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well-lnstallation []Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Khoring Destruction Slot Size; <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> A Gravity ❑Tremie ❑Other: Type of Method: <br /> Water ent 471b Water Cement 941b <br /> ai ons B2 eallons Bags <br /> Thickest Thinnest ABags Thickest Thinnest ++Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> as s 1 ✓ 5 10 1 Bentonite per 47 lb 1 1.411 2.47 <br /> s 10 2 ✓ 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 ✓ 15 30 3 <br /> 30 20 4 20 q0 q <br /> 115 25 5 25 50 5 <br /> is 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 3 40 80 B <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />